The Process | Insurance | Benefits | Risk Management Case Study

Risk Management

Our Client: Non-profit government Contractor providing Social Services with 1,500 employees.
The Challenges:
  • Firm suspected their fully insured medical plan with Blue Cross Blue Shield was an inefficient financing vehicle.
  • Firm was worried about the risk of predicting the cost per member associated with a partially self-funded program because of New York City contracted reimbursement rates.
  • Firm needed to continue to provide a robust benefits package to low paid employees with low copays and out-of-packet expenses.
  • Through our analysis in conjunction with nationally recognized independent actuarial firm, we performed a self-insured feasibility study.
  • Using our actuary’s HealthCost Guidelines Index, the largest private health and welfare actuarial model in the U.S., we accurately priced and predicted their costs using a partially self-funded program.
  • Firm change their plan to a partially self-funded program keeping the exact same provider network and plan designs.
  • Benefits plan design remained unchanged.
  • Through monitoring on an on-going basis along with actuarial projections and evaluations, the employer’s cost was predictable.
  • This consistent accuracy allowed them to price their city contracts effectively and their conversion rate on bids increased by 9%.
  • The client saved $998,000 (13%).